T helper cell immunity in pregnancy and influence on autoimmune disease progression

Graham, Jill; Longhi, Maria Serena; Heneghan, Michael A.

doi:10.1016/j.jaut.2021.102651

Cited by 32 publications

(29 citation statements)

References 208 publications

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“…Pregnancy represents a tolerating immune state due to paternal alloantigen presented by fetal tissue. Sex hormones and the placenta contribute to pregnancy maintenance by modifying T cell function, but changes in T cell immunity during pregnancy might be changed to produce autoantibodies [ 28 ]. However, transplacental autoantibodies may affect the fetus by the pathogenesis of autoantibodies [ 5 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Catch-up growth of infants born to mothers with autoimmune rheumatic disorders

et al. 2022

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Background In women with autoimmune rheumatic disorders (ARD), pregnancy complications or postpartum events are more frequent compared to the general population. Transplacental autoantibodies or cytokines influence various fetal and neonatal outcomes. We compared the growth patterns of babies born to mothers with ARD versus healthy mothers to assess the long-term growth outcomes of children born to women with ARD. Methods This was a retrospective age-matched cohort analyses of babies born to mothers with ARD from the hospitals belonging to the Catholic University of Korea between 2010 and 2017. Demographic and autoimmune laboratory test data of the mothers and newborns were assessed. Neonatal growth was measured in terms of height and weight, measured at birth and follow-up examinations. Results We enrolled 142 infants from mothers with ARD and 149 infants from healthy mothers. There was no significant difference between mothers with ARD and healthy mothers in terms of delivery age, parity, abortion, and premature delivery history. The mothers with ARD were diagnosed with systemic lupus erythematosus (81%), Sjogren syndrome (6%), and other autoimmune phenomena (11%). The groups were significantly different in terms of neonatal characteristics such as prematurity, gestational age, birth weight, and height, but not in Apgar score and delivery type. For most neonates, autoimmune laboratory results were normalized within 1 year, except for anti-La/SSB antibody, which remained high in some. The height and weight for age z-score were lower than the normal age groups at birth but showed catch-up growth by 2 years of age. Conclusions Low birthweight and prematurity at birth for neonates born to mothers with ARD could be caught up by 2 years of age, and maternal ARD does not affect the growth of their offspring.

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Section: Discussionmentioning

confidence: 99%

Catch-up growth of infants born to mothers with autoimmune rheumatic disorders

et al. 2022

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“…Progesterone administered to mice models showed an amplified number and function of Tregs through increased IL‐10 expression. [ 8 ] Altogether, this shift from Th1/Th17 toward the anti‐inflammatory Th2/Tregs may explain the well reported biochemical remission (BR) of AIH observed during pregnancy. LOBR during pregnancy can occur but most reports do not exceed beyond 15%.…”

Section: Pregnancy and The Immune System: Impact On Aihmentioning

confidence: 93%

“…[ 8 ] Administration of estrogen in pregnant mice models showed an increased expression of forkhead box P3 in Tregs, which plays a major role in its function. [ 8 ]…”

Section: Pregnancy and The Immune System: Impact On Aihmentioning

confidence: 99%

“…The Th1 and Th17 subtypes are required in the early stages of pregnancy for trophoblast invasion, angiogenesis, and successful implantation. [ 8 ] Th17 are also important for immunity against microbes. Beyond the early stages of pregnancy, the proinflammatory cytokines produced by Th1 and Th17 are associated with adverse pregnancy outcomes, including spontaneous abortions and preeclampsia.…”

Section: Pregnancy and The Immune System: Impact On Aihmentioning

confidence: 99%

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Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Chung

Heneghan

2022

Hepatology

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Autoimmune hepatitis (AIH) in pregnancy has many unique considerations.Evidence provided from single center studies with patient level data and nationwide population studies provide valuable insight into this complex situation. Because a planned pregnancy is a safer pregnancy, preconception counseling is a crucial opportunity to optimize care and risk stratify women with AIH. Women with chronic liver disease who receive preconception advice and counseling are more likely to achieve stable liver disease at conception and undergo appropriate variceal surveillance. Loss of biochemical response in pregnancy is associated with adverse outcomes in unstable disease. New onset AIH in pregnancy should be managed with classical treatment regimens. The continued use of immunosuppression in pregnancy, with the exception of mycophenolate mofetil, has not shown to adversely affect the rates of stillbirth or congenital malformation. Previously adopted immunosuppression withdrawal paradigms in pregnancy should no longer be considered advantageous, because remission loss postdelivery is likely (12%-86%). Population studies, report improved outcomes with preterm birth rates falling from 20% to 9%-13% in AIH pregnancies over a 20-year period.Newer data have also demonstrated an increased risk of gestational diabetes and hypertensive complications in AIH pregnancy, which has implications for management and preeclampsia prevention with aspirin use. This review aims to provide the framework to guide and manage pregnancy in AIH outlining pearls and pitfalls to ensure optimal outcomes for mother, baby and to reduce variation in practice.

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“…Substantial experimental evidence suggests that the protective effect of pregnancy may be related to the immunological changes that occur during normal pregnancy, allowing tolerance to fetal antigens and to autoimmune targets though preventing pathogen infections [8].…”

Section: Introductionmentioning

confidence: 99%

Rank-Rankl-Opg Axis in Multiple Sclerosis: The Contribution of Placenta

Passaponti

Ermini

Acconci

et al. 2022

Cells

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Women with multiple sclerosis (MS) can safely become pregnant and give birth, with no side effects or impediments. Pregnancy is generally accepted as a period of well-being in which relapses have a softer evolution, particularly in the third trimester. Herein, we hypothesized that the placenta, via its “secretome”, could contribute to the recognized beneficial effects of pregnancy on MS activity. We focused on a well-known receptor/ligand/decoy receptor system, such as the one composed by the receptor activator of nuclear factor-kB (RANK), its ligand (RANKL), and the decoy receptor osteoprotegerin (OPG), which have never been investigated in an integrated way in MS, pregnancy, and placenta. We reported that pregnancy at the term of gestation influences the balance between circulating RANKL and its endogenous inhibitor OPG in MS women. We demonstrated that the placenta at term is an invaluable source of homodimeric OPG. By functional studies on astrocytes, we showed that placental OPG suppresses the mRNA expression of the CCL20, a chemokine responsible for Th17 cell recruitment. We propose placental OPG as a crucial molecule for the recognized beneficial effect of late pregnancy on MS and its potential utility for the development of new and more effective therapeutic approaches.

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T helper cell immunity in pregnancy and influence on autoimmune disease progression

Cited by 32 publications

References 208 publications

Catch-up growth of infants born to mothers with autoimmune rheumatic disorders

Catch-up growth of infants born to mothers with autoimmune rheumatic disorders

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

Rank-Rankl-Opg Axis in Multiple Sclerosis: The Contribution of Placenta

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